Background: The cardiovascular side effects of fluoropyrimidines have been extensively reported (1). However, cardiotoxicity associated with capecitabine, a novel oral fluoropyrimidine prodrug increasingly used in advanced breast, colorectal, and gastric cancer, has been infrequently described.

Objective: To describe 3 cases of severe angina-like chest pain possibly or probably related to capecitabine treatment. These cases were reported to the Netherlands Pharmacovigilance Centre.

Case Reports: Patient 1, a 44-year-old woman in good clinical condition, was receiving chemotherapy for advanced ovarian cancer. When her disease progressed, she was treated with 1500 mg of capecitabine twice daily. On the third day of treatment, she developed severe, reversible angina-like chest pain. Treatment with capecitabine was discontinued, and symptoms of chest pain fully disappeared within 2 days.